Things did not go as planned at the Upper San Juan Health Services District (USJHSD) board of directors meeting Tuesday night. After calling the session to order, board chair Neal Townsend added four items to the agenda under new items: board representative to the Mary Fisher Medical Foundation, replacement of board member, representative to Mercy Regional Medical Center, and election of offices.

The reason for the new agenda items came to light an hour and a half into the board meeting when Townsend announced that directors Jim Knoll and Michelle Visel had both handed in their resignation, leaving the USJHSD without a female voice and one less voice with medical expertise.

“While the work is never done and change is always taking place and always leaving more to be done — I feel that I have done what I set out to do,” Knoll’s resignation e-mail states, continuing, “Of course, before I, Dick Blide, J.R. and many others set out on this course — I was living out my first goal — i.e. — to retire from Administrative work, travel and do some part-time clinical care. I feel it is time now to go back to my Goal #1.”

Visel’s resignation, however, gave a final critique of the functioning of the USJHSD and was read by Townsend to a silent board of directors.

“Frankly, I am disheartened at the lack of financial overview from either the finance committee or the board and especially tired of being the main board member that voices concerns about our financial situation,” Visel’s letter begins, and the tone is consistent throughout. “It is also no secret I believe it is our first responsibility as board members to be vigilant and proactive in the oversight of the hospital administration. In my opinion the board’s lack of oversight is gross negligence of our fiduciary responsibility to the public and I do not wish to be a part of a board that would allow that to happen … I have become too dismayed to continue expending the effort it has taken to bring these issues to light and I hope the future board requires more transparency and is willing to take a proactive role in verifying the financial information it is provided. My intent was to stay on long enough to nominate Jim (Knoll) for Chair as I felt he would have the ability to rein in our CEO who appears to only be satisfied if he can continue putting us at financial risk in order to grow a much larger healthcare facility than we are financially safely able to achieve.”

After reading the letter, Townsend told the board the responsibility “rests in his court as chair of the board.”

“This creates opportunity,” Director Gerald Baker said, adding “The future is always better than the past.” Baker also commented that, personally, he felt the board was transparent and “getting better all the time.”

“I apologize that some of the things I read were parting shots,” Townsend said.

“Both of them had great roles in turning the hospital from an idea to reality. They’ve been hard chargers and contributors, and I’m disappointed that they don’t want to be a part of it anymore,” Cochennet said. As to the remarks made in the letter referencing him, Cochennet said, “I have to respect their personal thoughts, and I’m very much appreciative of the contributions they’ve made.”

However, this was not the end of resignations.

Townsend, then, announced that J.R. Ford, due to business reasons, had resigned from representative on the Mercy Regional board.

“As far as feedback to the board as a whole, there was none,” Townsend said.

“So, this was a lost opportunity?” Baker asked; and Townsend responded, “Yes.”

Ford commented about his resignation in a phone interview with SUN staff.

“If I thought they were open-minded to it (feedback), I would have shared it,” Ford said and added that he did communicate with Townsend regularly.

There was no conclusion as to how the board will move forward in regards to filling vacant seats, restructuring the committees and having representation to different boards; however, the election of offices did take place. All the following were voted unanimously to the following positions: Director Malcom Rodger to board chair, Director Mark Floyd as vice-chairman, Baker as secretary and Director Karl Irons as treasurer.

Still, the evening had one more resignation. During the public comment period at the end of the meeting, David Bronson announced that in the next month, he would transition out of the position of operations manager for Emergency Medical Services (EMS) and into the position of a street paramedic.

Bronson said that, for a while, his low-key style fit well with the position and the district, but now, with different grants coming in, the position might “take a different style.” He reassured the board that he would stay on staff, “but in a different role.”

Since the resignation is so recent, there are no replacement prospects yet.

Other items of business included:

• PSMC Chief Financial Officer Dennis Wilson updated the board on the Business Improvement Plan, which was required due to the district not meeting last year’s 60-day cash on hand bond covenant. Wilson said that, of the 18 improvements detailed in the plan related to cash, seven have been met, including having 60 days of cash on hand.

“Those items that are complete have exceeded overall what the goal was,” Wilson sad.

• Wilson and Irons, on behalf of the finance committee, presented a service line analysis for 2011. The analysis showed that, while 70 percent of patients come to the PSMC for the lab or clinic, that makes up only 21 percent of the overall revenue. The emergency room, however, generated roughly $4.7 million in charges. Yet it was only infusion, imaging, inpatient and swing beds, and lab services which showed an overall gain last year.

Irons said that the main point to be garnered from this analysis is, “We need the mill levy.”

• In the CEO report, Cochennet informed the board that five surgical specialists are going through the credentialing process with the district to offer services in gynecology, plastic surgery, oncology and orthopedics.

“I feel like we’re ready to take on proceduralists,” Cochennet said.

• Wilson reviewed April’s financials.

“April was a very disappointing month,” Wilson said. Volumes were very low across the board, lower than in April 2011. The month ended with $156,840 total revenue less total expenses. One reason the bottom line impact of the low-volume month was not bad was due to the $347,202 received in tax revenue.